As Boundaries of Specialty Pharmacy Change, So Must Patient Support Services | Asembia AXS25

Until recently, specialty drugs were largely confined to distribution and delivery through specialty pharmacies and prescribed by specialists in a network that was largely separate and outside retail and other sectors of pharmacy, according to Michael Sarshad, MBA, a commercial managing director at Syneos Health Consulting.

Michael Sarshad, MBA

But now, specialty drugs are leaving their lane/network and becoming available at retail locations, and patients can acquire them through a variety of healthcare professionals (HCPs) and primary care providers (PCPs), not just through specialists. According to Sarshad, these trends are prompting a definitional question with important implications for payers, pharmacies and patients: What is a specialty drug ?

“I think specialty is a designation that’s going to go away in the future,” Sarshad said at Asembia’s AXS25 Summit.“It’s going to become one big pot, where we say, ‘Hey, there is no more specialty that we need to think about.’”

Sarshad was a member of a panel at the specialty pharmacy meeting in Las Vegas for a session titled “The Rise of Specialty in Gen Med... Are You Ready?” He and his fellow panelists painted a picture of change to the traditional contours of U.S. pharmacy distribution and services. This new era of wide access to specialty drugs will necessitate effective leveraging of artificial intelligence (AI), new technologies, and cross-functional expertise to ensure patients receive proper support and personalized care, they agreed.

Kimberly Plesnarski

“Pharma is due for a shakeup, especially in patient support,” panel moderator Kimberly Plesnarski, senior vice president of market access and patient support at Syneos, said to begin the session. “Technology is evolving at a breakneck speed, and healthcare professionals are demanding much, much better.”

Uncertainty abounds as the borders in pharmacy get rearranged. Recent data reflects the shift. The share held by specialty drugs among the industry’s total prescription dispensing revenues has grown from 24% in 2013 to almost 40% in 2023, according to Plesnarski. More than ever, HCPs are being asked to manage complex chronic conditions that require specialty medications as wait times at specialists build up to unprecedented numbers. According to Adrian Garcia, M.Ed., a managing director with Spherico, a market access communication unit of Syneos Health, simplification and effective communication are key aspects for pharmacy teams to be thinking about.

“The more and more you can integrate engaging communications into a workflow, the more effective it’s going to be,” Garcia explained.

Pharmacy workflows will get increasingly more complicated as specialty drugs make their mark in general medicine, Plesnarski said. Prior authorization (PA) is a wrinkle that many HCPs have reported hindering their product workflows, with respondents of a recent Syneos survey indicating that they are spending an extra 25 to 30 minutes per patient on the PA process for specialty medications. Approximately half (52%) of the respondents reported seeing an increase in workload overall, while nearly three-quarters (72%) responded that they tend to avoid products with complex PAs.

Kelly Carter

Tailoring patient support offerings and meeting the customer where they are will be critical to ensuring pharmacy care remains the gold standard, explained Kelly Carter, executive director of patient access at Amgen. General medicine isn’t built for specialty pharmacy, Carter said. That mismatch increases the strain on patients and pharmacists alike, she said. Despite these challenges, this evolution presents a great opportunity to implement new technologies to decrease turnaround times for benefit verifications and more efficiently recoup copayments from manufacturers.

“The unfortunate thing is that the education, I think, has been lacking,” Carter told the Asembia audience. “We can do a better job getting the message out to help patients really understand their benefit designs and what resources are available to them.”

Sarah Boyce, director of strategic operations and analytics at Syneos, put a more optimistic light on the situation when asked by Plesnarski how pharmacies might scale solutions for general medicine. Boyce spoke to the need to properly integrate AI in a proactive manner, rather than the reactive ways other technologies have been implemented in pharmacy in the past.

“It’s an incredibly exciting time,” Boyce said. “Not only is AI going to be able to handle that scale and demand, it is also going to lead to deep personalization to the patient, who is at the heart of all of this.”

But something critical is missing, according to Sarshad: training. “I’m hearing AI so much I want to throw up,” Sarshad joked, but the underlying sentiment was real; training among HCPs on how AI can be successfully utilized in their practice is critical for the many providers who simply are not experienced with this new technology. Sarshad said this ranges from explaining correct AI input to garner a specific output to hiring technology experts for the pharmacy team to support this transition. Above all, ensuring members of the pharmacy team possess a variety of expertise is essential for navigating the uncertainty of the future.

“If you’re going to be managing AI and managing a cross-functional team of experts, you have to be a curator,” Plesnarski said. “If you fall short on expertise somewhere but you have curated the right group around you, you’re going to get to the correct — and better — solution.”